naproxen + sumatriptan: clinical use

Prescribing considerations

• Confirm a clear migraine diagnosis and investigate atypical or new neurological symptoms before prescribing.
• Assess cardiovascular risk and gastrointestinal, renal, hepatic, bleeding and asthma-related risks.
• Review headache frequency, as repeated acute-treatment use can contribute to medication-overuse headache.
• Not recommended for people younger than 18 or older than 65 because appropriate safety and efficacy data are lacking.

Contraindications and cautions

• Ischaemic heart disease, previous myocardial infarction, coronary vasospasm, peripheral vascular disease or severe heart failure
• Previous ischaemic stroke or transient ischaemic attack
• Moderate or severe hypertension, or uncontrolled mild hypertension
• Active or recurrent peptic ulceration, gastrointestinal bleeding, or previous NSAID-associated bleeding or perforation
• Previous asthma, angioedema, urticaria, rhinitis or similar hypersensitivity caused by aspirin or another NSAID
• Severe renal impairment or moderate-to-severe hepatic impairment
• Concurrent or recent MAOI use, another triptan, or an ergotamine-type treatment
• Third trimester of pregnancy
• Hypersensitivity to either active ingredient or an excipient

Monitoring

• Check blood pressure and investigate clinically significant chest symptoms.
• Monitor renal function where renal perfusion is vulnerable.
• Watch for gastrointestinal bleeding, ulceration, fluid retention and worsening heart failure.
• Observe for serotonin syndrome when serotonergic antidepressants or lithium are clinically necessary.

Clinical pharmacology

Sumatriptan is a selective serotonin receptor agonist that produces cranial vasoconstriction and inhibits trigeminal activity. Naproxen is an NSAID that inhibits cyclooxygenase-dependent prostaglandin production.

Formulation and product differences

• Fixed-combination, film-coated oral tablet containing sumatriptan and naproxen sodium.
• The tablet has an optimised absorption profile and must not be split, crushed or chewed.
• It can be taken with or without food.
• It contains sodium as an excipient.

Tablet

Route: Oral

Strengths: 85 mg + 457 mg